We investigated the prevalence of obesity-related multimorbidity (i.e., co-occurrence of ≥2 obesity-related chronic diseases) and the risk of developing one disease in the presence of multimorbidity and degree of obesity in the U.S.


National Health and Nutrition Examination Survey data, 2007-2016, were used. We targeted hypertension (H), diabetes (D), coronary heart disease (C), and stroke (S). Age-standardized disease prevalence was calculated. We estimated the risk of developing each disease conditional on age, race/ethnicity, gender, measured body mass index, pre-existing disease(s), duration of pre-existing disease(s), and duration squared. We adjusted for the complex sampling design.


Our sample (n=14,243) represents 110,003,550 individuals in the U.S. population age 40-79 years. Age-standardized prevalence for obesity-related multimorbidity was 12.3%: 10.3%, 1.8%, 0.2% for two, three, and four diseases, respectively. H was most often the first diagnosed disease for populations with obesity-related multimorbidity. Compared with no pre-existing disease, (1) C+S increased the risk of H (multivariable-adjusted hazard ratio, aHR, 6.0, 95% confidence interval, CI, 4.1-8.6); (2) C+H+S increased the risk of D (aHR 8.2, 95% CI 3.6-19.0); (3) H+S (aHR 27.6, 95% CI 10.9-70.2), D+H+S (aHR 20.3, 95% CI 7.9-52.2), or D+S (aHR 13.1, 95% CI 4.2-40.8) increased the risk of C; and (4) C+D+H (aHR 32.6, 95% CI 12.2-87.1) or C+H (aHR 25.4, 95% CI 12.1-53.6) increased the risk of S.


Obesity-related multimorbidity was prevalent in the U.S. population with a high correlation between the development of these diseases. Prevention and intervention strategies are essential to reduce the burden of multimorbidity.